Surprised by a Medical Bill? You’re Not Alone
Surprise medical bills can happen to anyone. They are difficult to predict and even more difficult to prevent.
A recent study found that almost one-third of Americans who are privately insured received a surprise medical bill where their insurance did not pay as much as they had expected. Additionally, nearly 25% received a bill from a doctor from whom they did not expect to receive one.
For instance, months after receiving a special diagnostic mammogram, a woman might receive a shockingly high bill in the mail. She’s confused because the doctor who ordered the test and the x-ray specialist who performed her mammogram were both in-network and covered by her health insurance ― she even double checked just to be sure. She wasn’t expecting a bill for $2,000 after she paid her co-pays for the doctor’s visit and the subsequent test. So why did she receive this surprise medical bill? Because the diagnostic analysis of the mammogram was sent to an out-of-network radiologist to examine, which her insurance did not cover.
Technicalities within the health insurance system and healthcare providers place patients in the precarious position of determining what is covered and what isn’t. Patients who receive surprise medical bills often don’t know what to do or how to fight them, and many of those who resolve their surprise medical bills are still unsatisfied with how they were resolved or to what extent.
Surprise Medical Bills
Two of the most common ways consumers receive high surprise medical bills are related to multiple providers who are involved in a single procedure and or emergency medical situation.
- Multiple healthcare providers involved in a single procedure
As described in the situation above, problems arise when multiple providers are involved in a single procedure. Typically, if you are getting routine tests, such as providing a urine sample or having blood drawn, they can be executed and processed at the hospital’s lab and will be covered under your insurance as an in-network procedure. If you have a more complicated test or procedure, it can involve more healthcare professionals or specialists who are out-of-network. Unfortunately, patients are often left in the dark about this.
In the case of a surgical procedure, it is common for the anesthesiologist to be contracted by the hospital, as opposed to an employee of the hospital. In this case, the patient would receive a separate bill for the anesthesiologist as an out-of-network provider. Typically, this bill is very high.
- Emergency situations
During an emergency, such as a car accident or workplace injury, medical care is urgent and therefore pursued without considering any financial consequences. The patient or his or her guardian are not consulted before a procedure is done, removing all patient choice from care. The most important thing is ensuring the patient’s health and safety.
In many cases, the emergency room visit is covered under an insurance policy as an in-network provider, but the emergency room doctor is out-of-network. In this case, a consumer would receive two separate bills, and the insurance company is unlikely to cover an out-of-network emergency room doctor.
Tips to Avoid Surprise Medical Bills
There are a few simple and sensible steps you can take as a consumer to protect yourself from surprise medical bills; however, even the most diligent and conscious consumer can receive a surprise medical bill depending on the circumstances.
If you have a planned medical procedure coming up, do the following:
- Ask your doctor if there are multiple providers who will assist in the procedure and if each of those providers is in-network. Be sure to take detailed notes.
- Call your health insurance company to verify that each provider is covered under your current policy. If a provider is not covered or if there is a gap in coverage, ask your doctor to consider an alternative for that part of the procedure. If the doctor cannot find an alternative provider, try to negotiate with your insurance company. Once you are in agreement over what is covered and what is not, be sure to get that agreement in writing. This will help you in case you need to dispute a bill after the procedure.
Another way to avoid medical bill surprises is to thoroughly research health insurance plans prior to committing to one. Individuals need to weigh their perceived health risks against the coverage they want and the coverage available to them. It may be tempting to purchase the plan with the lowest premium, but doing so could leave you in a tough spot with several surprise medical bills. A health insurance plan with a low premium could have an extremely high deductible or gaps in coverage. This could leave you vulnerable to receiving a large and unexpected bill for what you thought would be a routine procedure.
Those over the age of 65 are at a pronounced risk for gaps in coverage because the State of Alaska does not have Medicare Advantage Plans (also known as Medicare Part C) through private insurers. This limits Alaskans who depend on Medicare to providers who will accept Medicare insurance.
While you cannot predict emergencies, you can negotiate your bill with your insurance company and doctors’ offices after an emergency visit or procedure. Sometimes doctors are willing to negotiate a lower payment if you can pay it in full.
Surprise medical bills often occur after accidents. If you’ve been in an accident and suffered injuries because of someone else’s negligence, retaining a personal injury attorney can help you negotiate with doctors or the insurance company to reduce your medical bills and other associated with the injury.
Contact the Law Offices of William D. Cook
If you are struggling with mounting medical bills, hospital liens, or wage garnishments as the result of an injury sustained in an accident caused by another party’s negligence, call the offices of William D. Cook at (800) 757-7757 or fill out our convenient online form to request a free consultation. We can review the unique circumstances surrounding your experience and help you determine your best course of action.
Consumer Reports survey finds nearly one third of privately insured Americans hit with surprise medical bills. (2015). Consumers Union. Retrieved from http://consumersunion.org/news/consumer-reports-survey-finds-nearly-one-third-of-privately-insured-americans-hit-with-surprise-medical-bills/
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.